Neurosurgical Interventions For Stroke

Eisenhower Neurosurgeon Farhad M. Limonadi, MD at work.The Stroke Program at Eisenhower Medical Center is the only stroke center in the Coachella Valley to be certified by The Joint Commission as a Primary Stroke Center. A principal reason for the designation is Eisenhower’s Acute Stroke Team, a multidisciplinary group comprised of Neurologists, Neuro-interventional Radiologists, Nurse Practitioners and Emergency Physicians — all trained to diagnosis and treat the different types of strokes. Eisenhower’s world-class Neurosurgeons are also key members of the team, playing a dual role; they conduct surgical interventions when necessary, but also apply their unique knowledge of the brain to the overall treatment protocol for Eisenhower stroke patients.

Stroke is the nation’s number three killer and a principal cause of physical disability. A stroke interrupts blood flow to the brain.When a stroke occurs, brain cells are deprived of oxygen and can begin to die within minutes, often leading to permanent damage. Treating stroke quickly, and restoring blood flow to the brain, is crucial to recovery.

“Strokes are critical medical emergencies,” says Eisenhower Neurosurgeon Farhad M. Limonadi, MD. “You have a window of opportunity to intervene when you can significantly affect the outcome and a patient’s quality of life.”

Eisenhower’s Stroke Team at works together to converge on the right diagnosis and course of action, which could mean dissolving the clot, or in some cases, surgery. The type of procedure depends on the type of stroke a person has had, as well as their personal medical history.

“There are some procedures that involve surgery. For example, the endovascular team at Eisenhower can utilize a minimally invasive approach to remove a clot if we believe the patient is not a candidate for dissolving it medically,” explains Dr. Limonadi. “That procedure is done by an endovascular surgeon. If the patient has had a hemorrhage, we can surgically evacuate the hemorrhage through a craniotomy, removing a small portion of the patient’s skull to access their brain.” Craniotomies can also be used to surgically remove clots that the medical team cannot dissolve.

“In addition to surgical skills, the Neurosurgeon brings extensive knowledge of the brain’s anatomy and physiology to the stroke team.”

Brain swelling, as a result of a stroke, can be another reason for surgery. “The injured brain can cause damage to the uninjured brain,” Dr. Limonadi says. “In the case of a critical emergency, we can operate to perform surgical decompression of the swollen brain, a procedure called a craniectomy [temporary surgical removal of part of the skull].”

If a narrowing of the carotid artery causes a patient’s stroke, surgeons can perform angioplasty (a procedure to repair or widen a blood vessel) to widen the artery, and insert a stent to prevent the narrowing from recurring.

In addition to surgical skills, the Neurosurgeon brings extensive knowledge of the brain’s anatomy and physiology to the stroke team.“Neurosurgeons are not just surgeons. They understand the physiology of the brain in a very detailed fashion,” says Dr. Limonadi. “When a patient is in intensive care, Neurosurgeons know how to manage the intracranial pressure; they understand the appropriate medication for controlling blood pressure; they know how to prevent hemorrhage.”

Dr. Limonadi adds that surgery is often the last option for most stroke patients, and should be done only if absolutely necessary. “Basically, our job is not to operate all the time, but to keep people from having to have surgery,” explains Dr. Limonadi. “We try to optimize their care so they don’t need to go into the operating room.”